International journal of obstetric anesthesia
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Int J Obstet Anesth · Apr 1995
Levels of anaesthesia and intraoperative pain at caesarean section under regional block.
This prospective study recorded levels of analgesia (loss of sharp pin prick sensation) and anaesthesia (loss of touch sensation) in 220 women during caesarean section under regional anaesthesia (70 epidurals, 150 spinals). At delivery the difference between analgesia and anaesthesia varied from 0-7 segments for epidurals and 0-9 segments for spinals. ⋯ No patient with a level of anaesthesia which remained above T5 experienced pain. These results indicate that assessing the adequacy of block by sharp pin prick may be misleading and that in the absence of spinal or epidural narcotics a level of anaesthesia up to and including T5 is required to prevent pain during caesarean section.
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Int J Obstet Anesth · Apr 1995
Epidural analgesia with 4 mg of morphine after caesarean section: modulating effect of epidural block compared to general anaesthesia.
Forty patients had epidural catheters placed for analgesia in active labour. For caesarean section patients in the epidural (EA) group (n = 20) had epidural anaesthesia with 0.5% bupivacaine supplemented if necessary with 2% lidocaine with adrenaline. Patients in the general anaesthesia (GA) group (n = 20) had standardized general anaesthesia for surgery. ⋯ Patients in the EA group consumed significantly less pain medication during the first 24 h after surgery (P = 0.0002). Itching was less frequent in the GA group (P = 0.011). It is concluded that epidural administration of 4 mg of morphine produces more effective postoperative pain relief when emergency caesarean section is conducted under epidural than when it is conducted under general anaesthesia.
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Int J Obstet Anesth · Apr 1995
Motor block during epidural infusions for nulliparous women in labour: a randomized double-blind study of plain bupivacaine and low dose bupivacaine with fentanyl.
Sixty nulliparous women received epidural infusions in labour of either 0.125% plain bupivacaine or 0.0625% bupivacaine containing 2.5 mcg/ml fentanyl both starting at 12 ml/h and titrated to maintain a sensory block to T10. Those women who received low dose bupivacaine with fentanyl took significantly longer to reach full cervical dilation (P < 0.05). There was no statistical difference between the groups in the number of additional epidural bolus doses required during the infusions. ⋯ The mode of delivery was similar in the two groups as was the satisfaction with epidural analgesia in both the first and second stages of labour and with labour overall. There were no significant differences in Apgar scores, umbilical cord blood pH levels or neurologic and adaptive capacity scores at 2 or 24 h. There was no significant difference in the incidence of symptoms 24 h after delivery.
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Int J Obstet Anesth · Jan 1995
Post partum headache after epidural analgesia without dural puncture.
In order to improve our knowledge of post partum headache, during a two-year period we studied a large population of pregnant patients of our institution using a four-stage process including two questionnaires (the first at 12-15 weeks' gestation and the second in the first week after delivery), a pre-anesthetic visit at 36 +/- 2 weeks' gestation and a computer printout obtained at delivery. Of 1058 patients for whom records were complete and who had epidural analgesia during labor not complicated by dural puncture, 128 (12.1%) complained of post partum headache. ⋯ Data from the medical history or from the current pregnancy as well as data obtained during delivery (maternal and fetal-neonatal) were not significantly different between those patients free of pain and those presenting with headache, except for a history of migraine and pregnancy-induced hypertension which were both associated with an increased risk of post partum headache. These risk factors should be considered in both clinical studies and obstetric malpractice claims.